Cardiopulmonary Bypass

Advances in Extracorporeal Life Support

1st Edition - November 30, 2022
Imprint: Academic Press
Editors: Kaan Kırali, Joseph S. Coselli, Afksendiyos Kalangos
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 9 1 8 - 0
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 9 1 9 - 7

Cardiopulmonary Bypass: Advancements in Extracorporeal Life Support provides comprehensive coverage on the technological developments and clinical applications of extracorp… Read more

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Cardiopulmonary Bypass: Advancements in Extracorporeal Life Support provides comprehensive coverage on the technological developments and clinical applications of extracorporeal technologies, including the underlying basic science and the latest clinical advances in the field. Written by experts around the world, this book comprises all characteristics of cardiopulmonary bypass as well as chapters regarding equipment, physiology and pathology, pediatric aspects and clinical applications. Important highlights include the latest updates regarding minimal invasive cardiopulmonary bypass (MICPB), extracorporeal circulatory and respiratory support (ECCRS) in cardiac and non-cardiac patients, ECMO support in COVID-19, and updated guidelines of extracorporeal technologies.

This book is an invaluable resource to clinicians, researchers and medical students in the fields of cardiothoracic surgery, cardiac anesthesiology, intensive care, and perfusion technology.

Cover image
Title page
Table of Contents
Copyright
List of contributors: volume I
List of contributors: volume II
About the editors
About the authors
Preface
Epigraph
Expressions of thanks
Editorial
1 Introduction
2 Native circulation, pulmonary passage, and gas exchange
3 Transforming the idea of artificial extracorporeal life support into reality
4 Artificial allocations for failed native protective mechanisms
5 Extracorporeal life support–team
6 Conclusion
Part I: Extracorporeal life support
Introduction to “surgical perspective”
Abstract
Introduction for “perfusional perspective”
Abstract
Part II: Artificial circulation and respiration
Chapter 1. Development of artificial circulation
Abstract
Main messages
Abbreviations
1.1 Introduction
1.2 Body
1.3 Summary
References
Chapter 2. Future artificial surface physiology
Abstract
Main messages
Abbreviations
2.1 Introduction
2.2 Blood–extracorporeal circulation surface interaction
2.3 Current technologies for modifying extracorporeal circulation surfaces
2.4 Summary
References
Chapter 3. Evolution of mechanical cardiac support
Abstract
Main points
Abbreviations
3.1 Initial work
3.2 First clinical application of the artificial heart
3.3 Advances in cardiac transplant and mechanical support
3.4 Development of continuous-flow pumps
3.5 Physiologic implications of continuous-flow pumps
3.6 The further development of the total artificial heart
3.7 Recent progress
Acknowledgment
References
Chapter 4. The future of artificial lung
Abstract
Main messages
Abbreviations
4.1 Introduction
4.2 Historical view
4.3 Existing extracorporeal life support devices
4.4 Extracorporeal devices configurations
4.5 Considerations for development of artificial lung devices
4.6 Ongoing development of paracorporeal respiratory-assist devices
4.7 Bioartificial lung: tissue engineering and cell-based technologies
4.8 Future perspectives
References
Chapter 5. Future noninvasive monitoring
Abstract
Main messages
Abbreviations
5.1 Introduction
5.2 The extracorporeal life support circuit and device
5.3 Lungs and ventilation
5.4 Cardiocirculatory monitoring
5.5 Tissue perfusion and microcirculation
5.6 Neurologic monitoring
5.7 Renal function
5.8 Limbs
5.9 Other organs
5.10 Future perspectives
References
Chapter 6. Three-dimensional printing in cardiopulmonary disease
Abstract
Main message
Abbreviation
6.1 Introduction
6.2 Image postprocessing and segmentation
6.3 Accuracy of three-dimensional–printed models
6.4 Clinical applications of three-dimensional printing in cardiopulmonary disease
6.5 Three-dimensional–printed models in fighting against coronavirus disease 2019
6.6 Three-dimensional–printed models in cardiopulmonary bypass
6.7 Three-dimensional–printed model simulation of hemodynamics of cardiovascular system
6.8 Three-dimensional printing in education and training of young physicians and researchers
6.9 Limitations and future directions
6.10 Summary and conclusion
References
Chapter 7. Guidelines for extracorporeal circulation
Abstract
Main messages
Abbreviations
7.1 Introduction
7.2 A guideline—what should it mean for ECC?
7.3 Current guidelines—qualification or potential GAPS?
7.4 Future directions for ECC
7.5 Conclusions
References
Part III: Cardiopulmonary bypass (CPB)
Chapter 8. Basics of extracorporeal circulation
Abstract
Main message
Abbreviations
8.1 Brief history
8.2 Heart–lung machine
8.3 Sites of cannulation
8.4 Components
8.5 Preoperative preparation
8.6 Anticoagulation for cardiopulmonary bypass
Acknowledgment
References
Chapter 9. Pathophysiology of cardiopulmonary bypass
Abstract
Main messages
Abbreviations
9.1 Introduction
9.2 Pathophysiology of systemic inflammation due to CPB
9.3 The inflammatory response through humoral systems
9.4 The inflammatory response through cellular systems
9.5 Antiinflammatory response syndrome
9.6 CPB-related clinical damages
References
Chapter 10. Microcirculation during cardiopulmonary bypass
Abstract
Main messages
Abbreviations
10.1 Introduction
10.2 Microcirculation and hemodynamic coherence
10.3 Negative impact of microcirculation on cardiopulmonary bypass
10.4 Summary and future perspectives
References
Chapter 11. Perfusion standards and guidelines
Abstract
Main messages
Abbreviations
11.1 History of evidence-based perfusion
11.2 Perfusion clinical practice guidelines
11.3 Perfusion standards and guidelines
11.4 Summary
References
Chapter 12. Mechanical pumps for cardiopulmonary bypass
Abstract
Main messages
Abbreviations
References
Chapter 13. Oxygenators for extracorporeal circulation: theory and practice fundamentals for clinicians
Abstract
Abbreviations
13.1 Historical notes in the development of oxygenators
13.2 Basic oxygenator requirements
13.3 Physiology of gas exchange
13.4 Components of the membrane oxygenator
13.5 The membrane oxygenator: preparation for use
13.6 Membrane oxygenator troubleshooting
13.7 Future perspectives
13.8 Conclusion
References
Chapter 14. Cannulations for cardiopulmonary bypass
Abstract
Main messages
Abbreviations
14.1 Introduction
14.2 Central cannulation
14.3 Peripheral cannulation
14.4 Cannulation in aortic arch operations
14.5 Cardioplegia line cannulation
14.6 Left ventricle vent
14.7 Types of cannulas
14.8 Monitoring on cardiopulmonary bypass
References
Chapter 15. Anesthesia during cardiopulmonary bypass
Abstract
Main messages
Abbreviations
15.1 Introduction
15.2 Drugs during cardiopulmonary bypass: routes of administration and dosage adjustment
15.3 Maintenance of anesthesia during cardiac surgery: impact on outcomes
15.4 Airway management and mechanical ventilation
15.5 Hemodynamic management during cardiopulmonary bypass
15.6 Glucose, electrolyte, acid-base management, and other drugs possibly administered during cardiopulmonary bypass
References
Chapter 16. Monitoring during cardiopulmonary bypass
Abstract
Main messages
Abbreviations
16.1 Introduction
16.2 Circulation monitoring
16.3 Respiratory monitoring
16.4 Neurologic monitoring
16.5 Anticoagulation monitoring
16.6 Blood gas analyzing monitoring
16.7 Renal monitoring
16.8 Temperature monitoring
16.9 Circuit monitoring
References
Chapter 17. Transesophageal echocardiography and cardiopulmonary bypass
Abstract
Main message
Abbreviations
17.1 Introduction
17.2 Cardiopulmonary bypass-related issues
17.3 Cardiac surgery adjunct
References
Chapter 18. Hemostasis during cardiopulmonary bypass
Abstract
Key messages
Abbreviations
18.1 Principles of hemostasis
18.2 Heparin role during cardiopulmonary bypass
18.3 Heparin reversal strategies
18.4 Heparin-induced thrombocytopenia
18.5 Alternatives to heparin in cardiopulmonary bypass
18.6 Management of refractory nonsurgical bleeding after cardiopulmonary bypass
References
Chapter 19. Myocardial preservation during cardiopulmonary bypass
Abstract
Main messages
Abbreviations
19.1 Introduction
19.2 History
19.3 Myocyte contractile metabolism
19.4 Myocyte ischemia–reperfusion injury
19.5 Myocardial protection during aortic cross-clamp (cardioplegia)
19.6 Types of cardioplegia
19.7 Temperature of cardioplegia
19.8 Cardioplegia delivery pathways
19.9 Other methods for myocardial protection
References
Chapter 20. Cerebral preservation during deep hypothermic circulatory arrest in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
20.1 Introduction
20.2 Mechanisms of neurological injury due to cardiopulmonary bypass
20.3 Strategies for brain protection
20.4 Summary
References
Part IV: Special cardiopulmonary bypass
Chapter 21. Cardiopulmonary bypass in pregnancy
Abstract
Main messages
Abbreviations
21.1 Introduction
21.2 Contemporary trends in utilization of cardiopulmonary bypass in pregnancy
21.3 Strategies for cardiopulmonary bypass in pregnant women
21.4 Other important considerations
21.5 Considerations for different cardiac diseases
21.6 Extracorporeal life support
21.7 Conclusions
References
Chapter 22. Cardiopulmonary bypass in neonates and infants
Abstract
Main messages
Abbreviations
22.1 Introduction
22.2 Overall mortality
22.3 Cardiopulmonary bypass circuit
22.4 Summary
References
Chapter 23. Cardiopulmonary bypass in pediatrics
Abstract
Main messages
Abbreviations
23.1 Introduction
23.2 The phase before the initiation of the pediatric CPB: arterial pump, circuit components, prime volume, anticoagulation, and cannulation
23.3 The phase of pediatric CPB: its physiology and methods of improvement and optimization
23.4 The phase of pediatric CPB discontinuation
References
Chapter 24. Cardiopulmonary bypass in thoracic aortic surgery
Abstract
Main messages
Abbreviations
24.1 Introduction
24.2 Proximal thoracic aorta repair
24.3 Distal thoracic aorta repair
24.4 Summary
Acknowledgments
References
Chapter 25. Cardiopulmonary bypass in lung transplantation
Abstract
Main messages
Abbreviations
25.1 Introduction
25.2 Technique/approach for cardiopulmonary bypass institution
25.3 Scenarios for use of cardiopulmonary bypass
25.4 Hybrid ECMO/CBP configurations
25.5 Summary
References
Chapter 26. Cardiopulmonary bypass in noncardiac thoracic surgery
Abstract
Main message
Abbreviations
26.1 Introduction and brief history
26.2 General concepts and anticoagulation
26.3 Summary
Supplementary data
References
Part V: Special situations for perfusion
Chapter 27. Perfusion ethics, accreditation, and education
Abstract
Main messages
Abbreviations
27.1 History of perfusion education
27.2 Perfusion curriculum—the cognitive domain
27.3 High-fidelity perfusion simulation—the psychomotor domain
27.4 Clinical rotations and internships—the affective domain
27.5 Conclusion
References
Chapter 28. Perfusion training
Abstract
Main messages
Abbreviations
28.1 Introduction
28.2 On-the-job training
28.3 Training during practical part of perfusion education
28.4 Practice of emergency situations
28.5 Summary
References
Chapter 29. Perfusion management
Abstract
Main messages
Abbreviations
29.1 Introduction
29.2 Standard monitoring during cardiopulmonary bypass
29.3 Management of optimal blood flow
29.4 Hemodynamic management
29.5 Fluid management
29.6 Anticoagulation management
29.7 Temperature management
29.8 Management of blood loss
29.9 Management of venous return
29.10 Summary
References
Chapter 30. Adverse events and complications during cardiopulmonary bypass
Abstract
Abbreviations
30.1 Introduction
30.2 Cannulation and adverse events
30.3 Adverse events due to gas supply
30.4 Adverse events due to perfusion
30.5 Adverse events due to drug administration
30.6 Special considerations about perfusion in pediatric patients
30.7 Final remarks
References
Chapter 31. Perfusion separation challenge
Abstract
Main messages
Abbreviations
31.1 Introduction
31.2 Definition of difficult weaning
31.3 Predictors of difficult weaning
31.4 Reperfusion time
31.5 Separation from cardiopulmonary bypass
31.6 Hemodynamic monitoring
31.7 Left ventricular failure
31.8 Right ventricular failure
31.9 Vasoplegic syndrome
References
Chapter 32. Perfusion for hyperthermic intraperitoneal chemotherapy by cardiopulmonary bypass machine
Abstract
Main messages
Abbreviations
32.1 Introduction
32.2 History
32.3 Peritoneum
32.4 Pathologic and metastatic cascade of peritoneal carcinomatosis
32.5 Cytoreductive surgery–hyperthermic intraperitoneal chemotherapy
32.6 The hyperthermic intraperitoneal chemotherapy procedure
References
Part VI: Miniaturizing cardiopulmonary bypass
Chapter 33. Miniaturizing cardiopulmonary bypass
Abstract
Main messages
Abbreviations
33.1 Introduction
33.2 The evolution of minimal invasive extracorporeal circulation
33.3 Classification of MiECC systems
33.4 MiECC: a multidisciplinary strategy—tips and pitfalls
33.5 The advantages of modular MiECC
33.6 Toward a “more physiologic” cardiac surgery
33.7 MiECC in evidence-based guidelines
33.8 Rationale for superiority of MiECC
33.9 Setting-up a MiECC program
33.10 MiECC: from a circuit to a therapy
References
Chapter 34. Minimally invasive extracorporeal circulation in cardiac surgery
Abstract
Main messages
Abbreviations
34.1 Introduction
34.2 The mechanics of minimally invasive extracorporeal circulation systems
34.3 Anesthesia considerations
34.4 What the perfusionist needs to know when operating a minimally invasive extracorporeal circulation system
34.5 Surgical considerations with minimally invasive extracorporeal circulation
34.6 Clinical outcomes with minimally invasive extracorporeal circulation
34.7 Coronary artery bypass graft: minimally invasive extracorporeal circulation compared to off-pump coronary artery bypass graft
34.8 Minimally invasive extracorporeal circulation in valve surgery
34.9 Minimally invasive extracorporeal circulation in congenital heart disease
34.10 Future directions
34.11 Conclusions
References
Chapter 35. Miniaturized cardiopulmonary bypass in heart valve surgery
Abstract
Main messages
Abbreviations
35.1 Introduction
35.2 What should miniaturized cardiopulmonary bypass mean for heart valve surgery?
35.3 Current strategies for miniaturized cardiopulmonary bypass during heart valve surgery
35.4 Conclusion
References
Chapter 36. MICPB in robotic cardiac surgery
Abstract
Main messages
Abbreviations
36.1 Introduction
36.2 Specialized perfusion circuits
36.3 Myocardial protection
36.4 Cannulation
36.5 Aortic occlusion
36.6 Operative planning and special considerations
36.7 Conclusion
References
Chapter 37. Minimally invasive cardiopulmonary bypass in pediatrics
Abstract
Main messages
Abbreviations
37.1 Introduction
37.2 Conventional cardiopulmonary bypass
37.3 Minimally invasive cardiopulmonary bypass components
37.4 Types of minimally invasive cardiopulmonary bypass circuits
37.5 Minimally invasive cardiopulmonary bypass advantages
37.6 Minimally invasive cardiopulmonary bypass concerns
37.7 Hemodilution and blood transfusion
37.8 Minimally invasive cardiopulmonary bypass and systemic inflammation
37.9 Minimally invasive cardiopulmonary bypass today
37.10 Minimally invasive cardiopulmonary bypass @University of Verona
37.11 Conclusions
References
Part VII: Organ injury and protection in cardiopulmonary bypass
Chapter 38. The metabolic aspects of cardiopulmonary bypass
Abstract
Main messages
Abbreviations
38.1 Introduction
38.2 Oxygen delivery and consumption during cardiopulmonary bypass
38.3 Acid–base management
38.4 Insulin and glucose metabolism during cardiopulmonary bypass
38.5 Electrolyte management
38.6 Effects of cardiopulmonary bypass on drug metabolism
38.7 Hormonal responses to cardiopulmonary bypass
References
Chapter 39. Inflammatory injury in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
39.1 Introduction
39.2 Plasma protease pathways
39.3 Cellular components
39.4 Cytokines
39.5 Clinical implications
39.6 Summary
References
Chapter 40. Inflammatory protection and immune support for cardiopulmonary bypass
Abstract
Main messages
Abbreviations
40.1 Introduction
40.2 Interventions that attenuate hematological activation by the cardiopulmonary bypass circuit or surgical field
40.3 Interventions that attenuate ischemia-reperfusion injury
40.4 Interventions with nonspecific antiinflammatory activity
40.5 Summary
References
Chapter 41. Lung injury in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
41.1 Introduction
41.2 Context
41.3 Risk factors for pulmonary dysfunction
41.4 Pathophysiology
41.5 Risk factors
41.6 Prevention of lung injury during cardiopulmonary bypass
41.7 Optimization of mechanical ventilation
41.8 Limiting blood product transfusion
41.9 Minimizing effects of ventilation on right ventricular function
41.10 Treatment options
41.11 Conclusion and future trends
References
Chapter 42. Pulmonary protection and respiratory support
Abstract
Main messages
Abbreviations
42.1 Introduction
42.2 Definition
42.3 Epidemiology
42.4 Pathophysiology
42.5 Monitoring of cardiopulmonary bypass–associated acute lung injury
42.6 Preventive and protective strategies
References
Chapter 43. Brain injury in cardiopulmonary bypass
Abstract
Main message
Abbreviations
43.1 Cardiopulmonary bypass circuit and the brain
43.2 Neuropathology of brain injury in cardiac surgery
43.3 Identification of high-risk patients: focusing on stroke prevention
43.4 Brain protection during cardiopulmonary bypass
43.5 Surgical strategies to reduce neurologic injury
43.6 Pharmacological strategies to reduce neurologic injury
43.7 Neurological and cognitive sequelae of the brain
References
Chapter 44. Cerebral protection and neurological support
Abstract
Abbreviations
44.1 Introduction
44.2 Categorization of central nervous system injury
44.3 Risk factors for central nervous system injury
44.4 Cerebral physiology
44.5 Therapeutic strategies
44.6 Postoperative management of acute ischemic stroke
References
Chapter 45. Kidney injury in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
45.1 Introduction
45.2 Definition and epidemiology
45.3 Novel biomarkers to early identify AKI and AKI progression
45.4 Preoperative risk factors
45.5 Pathophysiology of AKI and CPB
45.6 Prevention and treatment of AKI and CPB
References
Chapter 46. Renal protection and nephritic support
Abstract
Main messages
Abbreviations
46.1 Introduction
46.2 Incidence and mortality
46.3 Pathophysiology
46.4 Risk factors
46.5 Monitoring of perioperative cardiopulmonary bypass–associated acute kidney injury
46.6 Preventive and protective strategies
46.7 Kidney replacement therapy
46.8 Discontinuation of kidney replacement therapy
References
Chapter 47. Splanchnic protection and management in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
47.1 Brief introduction and physiopathology
47.2 Abdominal complications after cardiopulmonary procedure
47.3 Cardiopulmonary bypass strategies and considerations
47.4 Conclusion
References
Chapter 48. Intestinal protection and management in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
48.1 Introduction
48.2 Risk stratification
48.3 Preoperative optimization
48.4 Intraoperative management
48.5 Postoperative gastrointestinal complications, identification, and management
48.6 Future developments
48.7 Summary
References
Chapter 49. Endocrinological protection and management for cardiopulmonary bypass
Abstract
Mean messages
Abbreviations
49.1 Introduction
49.2 Cardiopulmonary bypass and thyroid gland
49.3 Cardiopulmonary bypass and adrenal gland
49.4 Cardiopulmonary bypass and pituitary gland
49.5 Cardiopulmonary bypass and pancreas
References
Chapter 50. Vessels’ injury in cardiopulmonary bypass
Abstract
Main messages
Abbreviations
50.1 Introduction
50.2 Arterial cannulation injuries
50.3 Venous cannulation injuries
50.4 Summary/conclusion
References
Chapter 51. Infectional protection and antimicrobial support for cardiopulmonary bypass
Abstract
Main messages
Abbreviations
51.1 Introduction
51.2 Immune system
51.3 Risk factors for infection
51.4 Prevention from infection
51.5 Summary
References
Part VIII: Extra corporeal membranous oxygenation (ECMO)
Chapter 52. Extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
52.1 Introduction
52.2 Basic principles
52.3 Indications
52.4 Extracorporeal membrane oxygenation circuits
52.5 Cannulation
52.6 Monitoring
52.7 Complications
52.8 Maintaining extracorporeal membrane oxygenation
52.9 Weaning
52.10 Transport–extracorporeal membrane oxygenation
References
Chapter 53. Extracorporeal membrane oxygenation contraindications
Abstract
Main messages
Abbreviations
53.1 Introduction
53.2 Contraindications in current published guidelines
53.3 Contraindications to VA ECMO and VV ECMO
53.4 Contraindications to extracorporeal cardiopulmonary resuscitation
53.5 Exploring the literature on frequently cited contraindications
53.6 Adjusting selection criteria based on resource availability
53.7 Summary
References
Chapter 54. Hemodynamic evaluation of cannulas for ECMO
Abstract
Main messages
Abbreviations
54.1 Introduction
54.2 Cannulation sites based on extracorporeal life support mode
54.3 Hemodynamic parameters used for cannula evaluations
54.4 Cannula evaluations for adult extracorporeal life support
54.5 Cannula evaluations for neonatal/pediatric extracorporeal life support
54.6 Summary
References
Chapter 55. Electrocardiogram-synchronized pulsatility for ECMO
Abstract
Main messages
Abbreviations
55.1 Introduction
55.2 Current state of ECG-synchronized pulsatile ECLS
55.3 Summary
References
Chapter 56. Cardiac protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
56.1 Introduction
56.2 Circulatory failure for extracorporeal membrane oxygenation indications
56.3 Monitoring cardiac function during extracorporeal membrane oxygenation support
56.4 Ventricular distension during extracorporeal membrane oxygenation treatment
56.5 Cardiac failure due to ventricular distension
56.6 Extracorporeal membrane oxygenation management for potent hemodynamic balance
References
Chapter 57. Pulmonary protection and management during extracorporeal membrane oxygenation
Abstract
Main message
Abbreviations
57.1 Introduction
57.2 Extracorporeal membrane oxygenation support for respiratory failure
57.3 Mechanisms of lung injury
57.4 Lung state optimization during extracorporeal membrane oxygenation support
57.5 Procedures and surgical intervention
57.6 Pulmonary protection during extracorporeal membrane oxygenation use for circulatory failure
57.7 Conclusions
References
Chapter 58. Hemorraghic protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
58.1 Introduction
58.2 Conditions associated with hemostatic imbalances
58.3 Anticoagulation
58.4 Monitoring anticoagulation
58.5 Bleeding and thrombotic complications associated with extracorporeal membrane oxygenation
58.6 Avoidance and treatment of bleeding complications
References
Chapter 59. Cerebral protection and management during extracorporeal membrane oxygenation
Abstract
Abbreviations
59.1 Incidence of acute neurologic injury during extracorporeal membrane oxygenation
59.2 Acute ischemic stroke and hypoxic ischemic brain injury
59.3 Intracranial hemorrhage
59.4 Cerebral monitoring during extracorporeal membrane oxygenation
59.5 Prevention of neurologic complications during extracorporeal membrane oxygenation
59.6 Managing acute neurologic complications during extracorporeal membrane oxygenation
References
Chapter 60. Renal protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
60.1 Introduction
60.2 Definition
60.3 Incidence
60.4 Extracorporeal membrane oxygenation-acute kidney injury
60.5 Kidney supportive treatment
60.6 Kidney replacement therapy
References
Chapter 61. Gastrointestinal protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
61.1 Introduction
61.2 Extracorporeal membrane oxygenation gastrointestinal complications
61.3 Medical therapy
References
Chapter 62. Vascular complications in extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
62.1 Introduction
62.2 Overview of extracorporeal membrane oxygenation cannulation strategies
62.3 Epidemiology of extracorporeal membrane oxygenation–associated complications
62.4 Common extracorporeal membrane oxygenation–associated vascular complications
62.5 Impact of vascular complications
62.6 Monitoring and diagnosing vascular complications
62.7 Preventing vascular complications in extracorporeal membrane oxygenation
62.8 Anticoagulation
62.9 Summary
Acknowledgments
References
Chapter 63. Infection protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
63.1 Introduction
63.2 Infections preceding extracorporeal membrane oxygenation
63.3 Infections during extracorporeal membrane oxygenation
63.4 Risk factors for infections during extracorporeal membrane oxygenation
63.5 Preventive practices
63.6 Consideration for treatment
63.7 Summary
References
Chapter 64. Inflammatory protection and management during extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
64.1 Introduction
64.2 Overview of inflammatory response to extracorporeal membrane oxygenation
64.3 Potential consequences of extracorporeal membrane oxygenation–related inflammation—does it really matter?
64.4 Underlying disease–extracorporeal membrane oxygenation interactions
64.5 Modulating inflammation during extracorporeal membrane oxygenation
64.6 Ameliorating ischemia-reperfusion injury during extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest
64.7 Summary
References
Part IX: Special situations for ECMO
Chapter 65. Ethical challenges and quality assurance of extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
65.1 Introduction
65.2 Ethical principles
65.3 Ethical challenges during extracorporeal membrane oxygenation initiation
65.4 Problems during maintenance
65.5 Traditional medicines and therapies while on extracorporeal membrane oxygenation
65.6 Issues related to extracorporeal membrane oxygenation termination
65.7 Quality assurance of extracorporeal membrane oxygenation programs
65.8 Conclusion
References
Chapter 66. Education and training for extracorporeal membrane oxygenation
Abstract
Abbreviations
66.1 The need for extracorporeal membrane oxygenation education
66.2 The evolution of extracorporeal membrane oxygenation courses
66.3 Education on ethics of extracorporeal support
66.4 Application of adult learning theories in extracorporeal membrane oxygenation education
66.5 Simulation as an ultimate learning tool
66.6 Summary
References
Chapter 67. Nursing care of the patient on extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
67.1 Introduction
67.2 Nursing team
67.3 Nursing care
67.4 Conclusion
References
Chapter 68. Transportation for ECMO
Abstract
Main messages
Abbreviations
68.1 Introduction
68.2 History
68.3 Transport on ECMO
68.4 Summary
References
Chapter 69. Weaning strategies for ECMO and awake-ECMO
Abstract
Main message
Abbreviations
69.1 Introduction
69.2 Weaning process
69.3 General and surgical considerations
69.4 Downgrading of va−ECMO to a single left- or right-sided device
69.5 Considerations for weaning failure
69.6 Summary
References
Part X: ECMO support in non-cardiac etiology
Chapter 70. Extracorporeal membrane oxygenation in neonates and infants
Abstract
Main messages
Abbreviations
70.1 Introduction
70.2 Diseases treated
70.3 Patient selection criteria
70.4 Pre-ECMO evaluation
70.5 Irreversible organ injury
70.6 Management
70.7 Expected results and long-term outcomes
70.8 Summary
References
Chapter 71. Continuous renal replacement therapy during extracorporeal membrane oxygenation in neonates and infants
Abstract
Main messages
Abbreviations
71.1 Introduction
71.2 Summary
References
Chapter 72. Extracorporeal membrane oxygenation in nonsurgical lung conditions
Abstract
Main messages
Abbreviations
72.1 Introduction
72.2 Initiation of ECMO support for nonsurgical lung conditions
72.3 ECMO support for nonsurgical lung conditions
72.4 Troubleshooting while on ECMO for nonsurgical lung conditions
72.5 Summary
References
Chapter 73. Lung surgery and extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
73.1 Introduction
73.2 Extracorporeal life support components
73.3 Extracorporeal life support modalities
73.4 Indications
73.5 Monitoring and management
73.6 Weaning from extracorporeal membrane oxygenation
73.7 Complications on extracorporeal life support
73.8 Summary
References
Chapter 74. Intracranial surgery and extracorporeal membrane oxygenation
Abstract
Main messages
Abbreviations
74.1 Introduction
74.2 Goals of extracorporeal membrane oxygenation and their implications for intracranial procedures
74.3 Effects of extracorporeal membrane oxygenation on cerebral circulation and physiology
74.4 Intracranial procedures in patients on extracorporeal membrane oxygenation
74.5 Conclusions
References
Chapter 75. ECMO in controlled reperfusion of whole body (CARL)
Abstract
Main messages
Abbreviations
75.1 Introduction
75.2 Medical background
75.3 Targeted and extracorporeal cardiopulmonary resuscitation
75.4 Controlled Automated Reperfusion of the whoLe body
75.5 Technical implementation of controlled reperfusion
75.6 Proof of concept
References
Chapter 76. Extracorporeal life support in accidental hypothermia
Abstract
Main messages
Abbreviations
76.1 Introduction
76.2 Pathophysiology
76.3 Staging of accidental hypothermia
76.4 Survival outcomes following extracorporeal-assisted rewarming
76.5 Normothermic versus hypothermic cardiac arrest—differences and outcomes
76.6 Extracorporeal life support techniques for accidental hypothermia
76.7 Hypothermia Outcome Prediction After ECLS (HOPE) score
76.8 Prognostic factors for extracorporeal-assisted rewarming
76.9 Patient selection, indications, and contraindications for ECLS rewarming
76.10 A stepwise approach to management of patient during ECLS rewarming
76.11 Logistical and other system issues
76.12 Future research
76.13 Conclusion
References
Chapter 77. Extracorporeal membrane oxygenation in trauma
Abstract
Main messages
Abbreviations
77.1 Introduction
77.2 Extracorporeal membrane oxygenation circuit basics
77.3 Extracorporeal membrane oxygenation in trauma
77.4 Conclusion
Acknowledgment
References
Chapter 78. Extracorporeal life support in pandemics
Abstract
Main messages
Abbreviations
78.1 Introduction
78.2 Evidence for extracorporeal membrane oxygenation in acute respiratory distress syndrome
78.3 Historical respiratory pandemics
78.4 Respiratory pandemics of the 21st century
78.5 Healthcare systems in pandemic
78.6 Nations during pandemics
78.7 Professional societies and international organizations during pandemics
78.8 Role of extracorporeal membrane oxygenation in future pandemics
78.9 Improvements for the future of extracorporeal membrane oxygenation
78.10 Conclusion
References
Chapter 79. ECMO in COVID–ARDS
Abstract
Main messages
Abbreviations
79.1 Introduction
79.2 Pulmonary pathophysiology in COVID–ARDS
79.3 ECMO indications in COVID–ARDS
79.4 ECMO configuration in COVID–ARDS
79.5 Interhospital vv-ECMO transfer in COVID–ARDS
79.6 Long-term patient-care on vv-ECMO
79.7 Postdischarge recovery
References
Part XI: ECMO support in non-surgical cardiac etiology
Chapter 80. Extracorporeal membrane oxygenation for challenging percutaneous intervention
Abstract
Main message
Abbreviations
80.1 Introduction
80.2 Extracorporeal membrane oxygenation assistance for high-risk percutaneous coronary intervention
80.3 Extracorporeal membrane oxygenation for transcatheter aortic valve implantation
80.4 Extracorporeal membrane oxygenation for ablation
80.5 Extracorporeal membrane oxygenation for MitraClip
80.6 Summary
References
Chapter 81. Extracorporeal membrane oxygenation for end-stage heart failure
Abstract
Main message
Abbreviations
81.1 Introduction
81.2 Patient selection, indications, and initial stabilization
81.3 Cannulation strategies
81.4 VA-ECMO management
81.5 Managing comorbidities
81.6 Complications
81.7 Overall outcomes
81.8 Special considerations
81.9 Summary
References
Chapter 82. Extracorporeal membrane oxygenation for cardiogenic shock
Abstract
Main messages
Abbreviations
82.1 Introduction
82.2 Function and hemodynamic aspects of VA-ECMO
82.3 Adverse hemodynamic effects of venoarterial extracorporeal membrane oxygenation
82.4 Cannulation strategies
82.5 Prognostic impact of venoarterial extracorporeal membrane oxygenation in cardiogenic shock
82.6 Predictors of survival in patients treated with venoarterial extracorporeal membrane oxygenation
82.7 Patients’ selection for venoarterial extracorporeal membrane oxygenation
82.8 Adverse events in venoarterial extracorporeal membrane oxygenation
82.9 Weaning from venoarterial extracorporeal membrane oxygenation
82.10 Contraindications of venoarterial extracorporeal membrane oxygenation use
82.11 Venoarterial extracorporeal membrane oxygenation versus different mechanical circulatory support
82.12 Concomitant left ventricle unloading in venoarterial extracorporeal membrane oxygenation
Conflict of interest
References
Chapter 83. ECMO for cardiopulmonary arrest (ECPR)
Abstract
Main messages
Abbreviations
83.1 Introduction
83.2 ECPR implementation
83.3 Selection of candidates for ECPR
83.4 Outcome ECPR after CA
83.5 Complications in ECPR
References
Part XII: ECMO support in surgical cardiac etiology
Chapter 84. Extracorporeal membrane oxygenation for postcardiotomy syndrome in adults
Abstract
Main Messages
Abbreviations
84.1 Introduction
84.2 Mechanism of postcardiotomy shock
84.3 Indications and goals of extracorporeal membrane oxygenation in postcardiotomy shock
84.4 Extracorporeal membrane oxygenation circuit components
84.5 Cannulation strategies
84.6 Patient management with extracorporeal membrane oxygenation
84.7 Adjunct circulatory support devices
84.8 Complications of extracorporeal membrane oxygenation
84.9 Outcomes
84.10 Summary
References
Chapter 85. ECMO for postcardiotomy syndrome in pediatric patients
Abstract
Main messages
Abbreviations
85.1 Introduction
85.2 Indications and contraindications for ECMO
85.3 Timing of ECMO initiation
85.4 Cannulation strategies
85.5 Strategies for weaning ECMO support
85.6 Outcomes
85.7 Summary
Conflict of interest
References
Chapter 86. ECMO for post-LVAD right ventricular failure
Abstract
Main message
Abbreviations
86.1 Introduction
86.2 Anticoagulation
86.3 Weaning
86.4 Removal of right heart bypass
86.5 Complications
86.6 Alternatives to extracorporeal membrane oxygenation implantation
86.7 Conclusion
Funding
References
Chapter 87. ECMO in thoracic transplantation
Abstract
Main message
Abbreviations
87.1 ECMO in lung transplantation
87.2 ECMO prior to lung transplant
87.3 Use of intraoperative ECMO in lung transplantation
87.4 ECMO for postoperative support in lung transplant
87.5 ECMO in heart transplant
References
Part XIII: Non-ECMO artificial life support
Chapter 88. Non-extracorporeal membrane oxygenation artificial circulatory support devices
Abstract
Main messages
Abbreviations
88.1 Introduction
88.2 INTERMACS classification
88.3 Short-term mechanical circulatory support
88.4 Monitoring of mechanical circulatory support
88.5 Anticoagulation
88.6 Weaning
88.7 Complications
88.8 Summary—future directions
References
Chapter 89. Nonextracorporeal membrane oxygenation artificial respiratory support devices
Abstract
Abbreviations
89.1 Mechanical ventilators
89.2 Noninvasive respiratory support
89.3 Inhaled nitric oxide
89.4 Extracorporeal CO2 removal
89.5 Microfluidic oxygenator
References
Chapter 90. Non-extracorporeal membrane oxygenation artificial circulatory support for postcardiotomy syndrome
Abstract
Main message
Abbreviations
90.1 Introduction
90.2 Intraaortic balloon pump
90.3 Impella
90.4 TandemHeart system
90.5 CentriMag
90.6 Durable LVAD
90.7 Anticoagulation
90.8 Device selection
90.9 Conclusion
References
Chapter 91. Non-ECMO artificial circulatory support for percutaneous interventions
Abstract
Main messages
Abbreviations
91.1 Mechanical support devices
91.2 Percutaneous procedures with mechanical support
91.3 Vascular closure devices
91.4 Future of percutaneous mechanical circulatory support
References
Chapter 92. Non-ECMO artificial life support for thoracic transplantation
Abstract
Main message
Abbreviations
92.1 Introduction
92.2 Nonextracorporeal membrane oxygenation artificial life support for heart transplantation
92.3 Summary of artificial life support devices for heart transplantation
92.4 Nonextracorporeal membrane oxygenation artificial life support for lung transplantation
References
Epilogue
Index

Kaan Kırali

After finishing the Medicine Faculty of Istanbul University in 1990, Prof Kırali fulfilled MD, MSc medical mandatory service duty and began his residency training in Koşuyolu Heart and Research Hospital in 1992. Following 5 years of assistant education, he was in England and the USA for education and training in 1998. He performed his work mostly in the field of videoscopic and minimally invasive cardiac surgery, and he became a consultant cardiovascular surgeon in 1998, Assistance Professor in 1999, Associate Professor in 2002, and chief in 2005 at the same hospital. Over the last 20 years, he has focused his scientific interests on topics related to cardiovascular repairs requiring special experience. With his expertise in coronary artery surgery, minimal invasive cardiac surgery, valve repair, and aortic root surgery, he has established new methods for awake coronary bypass revascularization, new surgical approach for AVR during first and re-operations, aortic valve sparing procedure, and radiofrequency ablation. He is the pioneer of awake complete CABG with BIMA and has also developed a new aortotomy incision technique for all kinds of aortic valvular or subvalvular interventions during first and re-operations, which simplifies the procedure with/without aortic valve insertion. He has experience on cardiac failure during ECMO and developed a specific design for recovery. He has been the director of transplantation department since 2015.

Affiliations and expertise

Professor, Koşuyolu High Specialization Education and Research Hospital, Türkiye

Joseph S. Coselli

Prof. Joseph Coselli is the chief Professor of Surgery, of the Division of Cardiothoracic Surgery and the Executive vice-chair of Michael E. DeBakey Department of Surgery at Baylor College of Medicine, United States. He has specialized in the evaluation and treatment of aortic disease, including the aortic valve and root, the aortic arch, and the thoracoabdominal aorta, using open surgical and endovascular techniques. In 40 years of service, he has performed more than 10,500 aortic repairs, including more than 3700 repairs of thoracoabdominal aortic aneurysms, for which he is world-renowned.

Affiliations and expertise

Professor, Baylor College of Medicine, USA

Afksendiyos Kalangos

Prof Kalangos MD, PhD is a Greek-Swiss cardiovascular surgeon and Philanthropist. He currently serves as the Chairman of the Department of Pediatric and Congenital Cardiovascular Surgery at Mitera Hospital in Athens and as a full Professor of Pediatric Cardiovascular Surgery at Koc University Hospital in Istanbul, Türkiye. He is the President and founder of the Kalangos Foundation, the President and founder of the Global Forum on Humanitarian Medicine in Cardiology and Cardiac Surgery and the President and co- founder of Global Heart Network. He was the former President of the World Society of Cardiovascular and Thoracic Surgeons in 2014-2015 and is currently the treasurer of the society. He is also the inventor of the Kalangos biodegradable annuloplasty Rin. This device is being used in the repair of the mitral and tricuspid valves especially in children.

Affiliations and expertise

Professor, Mitera Children’s Hospital, Greece

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Cardiopulmonary Bypass

Advances in Extracorporeal Life Support

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Kaan Kırali

Joseph S. Coselli

Afksendiyos Kalangos

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